Over-the-scope clip-assisted closure of colocutaneous fistula.

Abstract

A 22-year-old woman sought treatment because of chronic intermittent feculent discharge through an opening on her skin in her right lower abdomen. She had received a cecostomy port at the age of 3 for chronic constipation and received an enema through the port for management of her chronic constipation. Her constipation improved with age, and the cecostomy port was subsequently removed approximately 3 years before the current presentation. Subsequently she had persistence of the fistula and had a chronic intermittent feculent discharge from the fistula opening (Fig. 1A). She did not have any other symptoms or difficulties. Colonoscopy with over-the-scope clip–assisted closure of the fistula was planned. Colonoscopy showed a normal terminal ileum and colonic mucosa. The patient was placed in the supine position, and a 0.025-inch guidewire was introduced through the cutaneous portion of the colocutaneous fistula. The guidewire was seen entering the cecum on endoscopic view, confirming the location of the colocutaneous fistula (Fig. 1B). A 12/6 type gc over-the-scope clip (OTSC) applicator cap was mounted on the tip of the endoscope (Fig. 1C). A therapeutic upper endoscope was used to match the size of the available OTSC. The endoscope was advanced to the colocutaneous fistula site, previously located with the help of a guidewire (Fig. 1D). The guidewire was removed, and a tissue grasper was used to grasp and pull the fistula opening inside the cap; subsequently, clip closure was performed (Fig. 1E). Closure of the fistula was confirmed by fluoroscopy and endoscopy because the guidewire could no longer be advanced from the cutaneous opening of the fistula (Fig. 1F). The patient was subsequently followed up 8 weeks after the procedure, and her prior symptoms of feculent discharge from the skin opening had resolved. We demonstrate successful use of over-the-scope clip application for the closure of a colocutaneous fistula (Video 1, available online at www.VideoGIE.org). All authors disclosed no financial relationships relevant to this publication. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJiZjU2ODk2MTlhZjY3ZDM0Y2VkMzg0NTY3NDg5NDcxNCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4NDcxNDg4fQ.G72DyXf488-BvtLupCKUiLr8fcPJ27M2EZGTpxTL4XFWGpRJrbdYtnTGWVwTIFeSaX6a2uNtKbKDY9fPUZJIfl3PlyAp1N86X1yM15xNYeUK2RSYciefAt5NJDgwueAW2Wwyf8HlwhtSNHEVXu00nk3ujYCkOzSIE35t9VwEG7YQs1E3xwA0f94pQI6PV0iWxRm3fpTZnFoU3eQoxffFOt7MqNS2Jh-9AZtdNI8WSzsR4c7-h1CsGzqUVkw8C-jbiwhwCNN5SRIp8CXzGwufYS73jh3oflrK42d_DpDXrqfP_aR79QftoMzfLxw5frUgsNuZdZT2sbUz48QQKDneLw Download .mp4 (52.07 MB) Help with .mp4 files Video 1Over-the-scope clip–assisted closure of colocutaneous fistula. Download .docx (.02 MB) Help with docx files Video Script